Trump Renews Fight to Repeal Affordable Care Act

President Trump is again focusing on one of his promises during the 2016 campaign: to abolish the Affordable Care Act.

The legislation, commonly known as Obamacare, greatly expanded low-income and working-class Americans’ eligibility for Medicaid. More than 20 million additional people are now getting health insurance from private companies through the federal program.

Democrats vow to resist the administration’s efforts to end the ACA. Most of them favor making it even easier to qualify for the coverage, and some want to enact a “Medicare for all” system guaranteeing health insurance for everyone.

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President Trump is again focusing on one of his promises during the 2016 campaign: to abolish the Affordable Care Act.

The legislation, commonly known as Obamacare, greatly expanded low-income and working-class Americans’ eligibility for Medicaid. More than 20 million additional people are now getting health insurance from private companies through the federal program.

Democrats vow to resist the administration’s efforts to end the ACA. Most of them favor making it even easier to qualify for the coverage, and some want to enact a “Medicare for all” system guaranteeing health insurance for everyone.

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Trump Renews Fight to Repeal Affordable Care Act

-By Jim Owen

President Trump is again focusing on one of his promises during the 2016 campaign: to abolish the Affordable Care Act.

The legislation, commonly
known as Obamacare, greatly expanded low-income and working-class Americans’
eligibility for Medicaid. More than 20
million additional people are now getting health insurance from private
companies through the federal program.

Democrats vow to resist the
administration’s efforts to end the ACA. Most of them favor making it even
easier to qualify for the coverage, and some want to enact a “Medicare for all”
system guaranteeing health insurance for everyone.

Battle in the Courts

In late March, Justice
Department officials called for repealing the ACA. They filed a motion
in the U.S. appellate court in New Orleans stating that federal District Judge
Reed O’Connor was right in December when he decided the law violates the
Constitution.

The Texas judge ruled that
the ACA became illegal with last year’s passage of a tax bill which eliminated
the individual mandate – a provision that required everyone to obtain health
insurance or incur a tax penalty.

O’Connor agreed with
Republican officeholders in 20 states who were the plaintiffs in the case. The
lawsuit claimed that without the individual mandate, the ACA is
unconstitutional because it no longer falls under tax regulations.

There was some irony in the
argument. Since the inception of Obamacare, Republicans have denounced the
individual mandate. Conservatives, and even some liberals, consider the
requirement an example of government overreach.

They claim that Congress has
no right to force people to buy insurance. In 2012, the Supreme Court approved
the mandate because it was essentially a tax that lawmakers are empowered to
enact.

The court system appears to be Trump’s only route for abolishing the Affordable Care Act. Due to the Democratic majority in the House of Representatives, any attempt to gut the law is almost certain to fail.

The political dynamics may
change if Republicans retake control of the House in the 2020 elections.
However, recent polling has indicated that the GOP is in danger of losing its
majority in the Senate, as well.

Provisions of the ACA﻿

Despite Republican
opposition, Congress approved Obamacare in early 2010. Obama signed the measure
into law, bringing about the biggest changes in the country’s health-care
system since the creation of Medicare and Medicaid in 1965.

Liberal Democrats sought to completely
overhaul the system by having the government provide health insurance.
Following months of heated debate, lawmakers maintained the private insurance
system – with government subsidies and regulations.

They rejected a “public
option” that would have allowed Americans to purchase health insurance from the
government rather a private company. Those who got their coverage from
employers were allowed to keep those policies. But the ACA imposed requirements
on individuals, employers, health-care firms and the insurance industry.

The goal was to expand access
to health care, lower the cost of medical treatment and improve the delivery of
care. The law permitted people to continue receiving coverage under their
parents’ policies until the age of 26. Companies with 50 or more employees had
to offer comprehensive insurance plans that their workers could afford.

Unemployed people, as well as
those employed in small businesses, were subject to the individual mandate.
They could buy insurance through either a state-level exchange or the federal
insurance “marketplace.” Everyone under the age of 65 whose incomes were below
133 percent of the official poverty line are eligible for the lower-cost
coverage.

Some states, notably those
with conservative governors, turned down federal funding to set up the
exchanges. Their opposition to the ACA, on constitutional grounds, resulted in
the low-income residents of certain states remaining uninsured.

The law prohibited insurance
companies from denying coverage, or raising premiums, on customers with
pre-existing medical conditions. All policies had to include preventive
services free of charge to individuals. In addition, the ACA demanded more
efficiently operated services and the use of advanced health-information
technology. The law rewarded providers with incentives for reducing waste and
fraud while improving access to care.

In a review of the law five years after it went into effect, the National Institutes of
Health issued a review of the “immediate and long-term effects.” The government
agency cited “peer-reviewed scholarly journals” that had published analyses of
the ACA, as well as information the government compiled.

The review confirmed that
Medicaid expansion, federal subsidies and health-insurance exchanges (through
which individuals sign up for coverage) had enabled millions of Americans to
obtain insurance.

However, the NIH found that
health care was still too expensive for many people to afford. Officials wrote
that income and race continued to play significant roles in determining whether
an individual was covered.

Pros of the ACA

Proponents of the Affordable Care Act criticize Trump and express outrage that the United States is the only industrialized country which does not guarantee health care for all its citizens. They advocate a system similar to those in Canada and Europe, where governments have replaced insurance companies and regulated all aspects of health care. Obamacare supporters believe the government should ensure coverage for more, not fewer, people.

Democrats warn that if the
ACA is repealed, tens of millions of Americans will lose their insurance
coverage. That would not only endanger people’s health; it also would cause
more workplace absences and burden emergency services. Lacking preventive and
early care, medical conditions could worsen to the point that treatments become
much more expensive.

The ACA is the only federal
statute preventing insurers from dropping coverage for customers with
pre-existing conditions. Abolition of the law would deprive hospitals and
clinics of the federal funding they rely upon to remain open. Rural hospitals
across the country are already shutting down due to financial problems.

Forbes cautioned that getting
rid of Obamacare also would reverse policy changes the Department of Health and
Human Services has made the past two years. The agency is conducing
demonstration projects in anticipation of bringing down the cost of prescription
drugs – a major problem for low-income Americans.

Cons of the ACA

For Trump and others, their opposition to the Affordable Care Act centers on two primary concerns: the cost of the system and the role of government.

The law brought about a
nearly $2 trillion hike in annual federal spending on health care, though cuts in the Medicare budget are covering some
of expense. One projection estimates that the cost of Medicaid expansion
(including the subsidies beneficiaries receive to help them afford insurance)
will total more than $1.8 trillion between 2015 and 2025.

Conservatives note that the
spending is adding to the federal deficit, which already has soared to record
levels. The budget shortfall threatens the stability of the nation’s economy.

The ACA decreases payments to
companies providing services to Medicare patients, which is designed to
partially compensate for the cost of subsidizing coverage for others. The
payment cuts are expected to amount to more than $700 billion from 2013 to
2022. The Heritage Foundation predicted that as a result, elderly Americans
will find it more difficult to obtain quality medical services.

Another downside to the law
is that millions of people have lost, or are in danger of losing, the health
insurance they get from the private sector. The ACA has caused problems in
for-profit insurance markets by forcing companies to provide additional
benefits.

Four million fewer Americans
reportedly were enrolled in employer-funded insurance plans in 2014 than the
previous year. That canceled out more than 60 percent of the increase in
insurance coverage resulting from Obamacare.

Huge numbers of people have
been denied the right to see doctors of their choice. They must choose an
ACA-approved provider, a requirement that the government insists is necessary
to control costs. A study by consultants at McKinsey and Co. discovered that
almost half the insurance exchanges have “narrowed” doctor choices.

The law has not brought down
the overall expense of health care in the United States, as Obama and other
Democrats pledged it would. In 2014, the first year of the individual and
employer mandates, many exchange customers were paying more than they did for
private insurance the previous year. Premiums for employer-provided plans
continue to rise, as well.

The ACA imposes 18 tax
increases, penalties and fees that were projected to give the government more
than $770 billion between 2013 and 2022. Among the levies are taxes on medical
devices and insurance companies.

Beyond the financial
considerations, Obamacare offends conservatives because it is a rejection of
the market-based system. Most Republicans see the law as a threat to the concept
of supply and demand, as well as an expansion of government power.

The problem is shaping up to
be a major issue in the 2020 congressional and presidential elections.
Democratic candidates are telling their party’s voters that they will protect
Obamacare and go even further.

Several White House hopefuls
are espousing Medicare for all. They include Sen. Bernie Sanders of Vermont, a
political independent who describes himself as a democratic socialist.
Universal health care also is the subject of legislation recently introduced in
Congress.